More than 23% of patients with breast cancer who undergo breast-conserving surgery followed by subsequent surgery do not receive the full benefits of surgery due to added costs and complications, according to research published in JAMA Surgery (online August 2, 2017; doi: 10.1001/jamasurg.2017.2661).
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Breast-conserving therapy tops mastectomy for early breast cancer
Breast Conserving Therapy More Likely to Result in Recurrence Than Mastectomy
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Early-stage breast cancer is often treated with mastectomy, but the alternative option of undergoing breast-conserving surgery has shown lower complication rates, comparable patient-reported quality of life, and equivalent or better survival rates. These benefits may not be entirely realized in patients who undergo repeated breast-conserving surgery in an attempt to increase their resection margin. Associated costs and complications resulting from additional surgery is not well defined.
Leanne N Metcalfe, PhD, Health Care Services Corporation (Chicago, IL), and colleagues conducted a retrospective review of insurance claims data to assess clinical complications and economic outcomes of patients who underwent breast-conserving surgery. Claims data were analyzed for 9837 women undergoing breast-conserving surgery, 2282 of whom were classified as having a repeated surgery (a second open-breast surgery within 90 days of the initial breast-conserving surgery). The analysis included resulting complications and total cost of all allowed health care claims within 2 years following diagnosis.
Researchers found that the mean cost for a patient undergoing a repeated surgery was $16,072 higher, and 56.4% of those added costs were incurred within 6 months after the initial breast-conserving surgery. Mean 2-year total health care costs were increased for those undergoing a repeated breast-conserving surgery and those undergoing a subsequent mastectomy ($11,621 and $26,276, respectively). Total increased costs owing to a repeated surgery were deemed statistically significant; mean cost without an additional surgery was $89,016 (95% CI, $87,132-$90,899) compared with $105,088 (95% CI, $101,408-$108,768) for those who underwent a repeated surgery (P < .001).
Additionally, the likelihood of a patient undergoing a repeated surgery of experiencing at least one complication was 47.6% higher and multiple complications was 89.1% higher than for patients undergoing a single breast-conserving surgery.
“Although many women will continue to benefit from breast-conserving surgery, these findings demonstrate quantitative evidence of a patient-centered and fiscal requirement to implement techniques to reduce breast-conserving surgery reoperations, including advanced margin evaluation,” researchers concluded.—Zachary Bessette
